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首页> 外文期刊>Esophagus >Decreased preoperative plasma substance P concentration is likely-associated with postoperative silent aspiration after esophagectomy
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Decreased preoperative plasma substance P concentration is likely-associated with postoperative silent aspiration after esophagectomy

机译：食管切除术后术前血浆P物质浓度降低可能与术后无声抽吸相关

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Background Postoperative pneumonia is the most common complication after esophagectomy and is closely associated with swallowing dysfunction and silent aspiration. Silent aspiration in the elderly is associated with decreased secretion of substance P (SP), which controls the swallowing and cough reflexes. The majority of patients with esophageal cancer are elderly. We hypothesized that surgical stress would decrease SP secretion, thereby increasing the risk of postoperative aspiration after esophagectomy, and prospectively investigated. Methods Thirty patients with esophageal cancer scheduled to undergo esophagectomy were enrolled in the study. Plasma and salivary SP concentrations and cough reflex sensitivity were measured before surgery and on postoperative days 2 and 7 to examine the association with postoperative aspiration. Results Postoperative silent aspiration was observed in 6 patients, 4 of whom developed pneumonia. Plasma SP concentration did not change significantly during the perioper-ative period. Salivary SP concentration and cough reflex sensitivity could not be measured in nearly one-third of patients because of postoperative dry mouth and unwillingness of patients to undergo measurement, respectively; thus, these perioperative changes could not be assessed. Preoperative plasma and salivary SP concentrations had a significant association with postoperative aspiration on univariate analysis and multivariate logistic regression analysis using variables selected by stepwise forward selection identified preoperative plasma SP concentration as the only significant risk factor for postoperative aspiration (p = 0.023). Conclusion Definitive results supporting our hypothesis could not be obtained. However, multivariate analysis suggested that decreased preoperative plasma SP concentration is likely associated with postoperative silent aspiration after esophagectomy.
机译：背景术后肺炎是食管切除术后最常见的并发症，与吞咽功能障碍和无声吸入密切相关。老年人无声吸入与P物质（SP）分泌减少有关，P物质控制吞咽和咳嗽反射。食道癌患者大多数是老年人。我们假设手术压力会减少SP的分泌，从而增加食管切除术后术后误吸的风险，并进行了前瞻性研究。方法纳入计划行食管切除术的30例食管癌患者。在手术前以及术后第2和第7天测量血浆和唾液SP浓度以及咳嗽反射敏感性，以检查与术后抽吸的关系。结果6例患者术后无声抽吸，其中4例发生肺炎。围手术期血浆SP浓度无明显变化。由于术后口干和患者不愿进行测量，在近三分之一的患者中无法测出唾液SP浓度和咳嗽反射敏感性。因此，无法评估这些围手术期的变化。术前血浆和唾液SP浓度与术后抽吸的单因素分析和多因素logistic回归分析之间存在显着相关性，使用逐步向前选择所选择的变量将术前血浆SP浓度确定为术后抽吸的唯一重要危险因素（p = 0.023）。结论无法获得支持我们假设的确定性结果。但是，多因素分析表明，食管切除术后术前血浆SP浓度降低可能与术后无声抽吸有关。

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